This is an application for a Cancer Prevention, Control, Behavioral and Population Sciences Career Development Award using the K07 mechanism. The purpose of the award is to provide Dr. Xiaomei Ma protected time and additional training and mentoring so she could become an independent investigator. The myelodysplastic syndromes (MDS) are a group of clonal proliferative bone marrow disorders resulting in dysmyelopoiesis and peripheral blood cytopenias. Although MDS has long been considered a pre-leukemic disorder, it is better viewed as a form of cancer because of the clonal nature. Despite MDS's poor prognosis and a likely increasing incidence, understanding about the etiology and factors affecting survival and quality of life is very limited, which may be due, at least in part, to the biological heterogeneity of the disease. In 2003-2004, the US congress identified MDS as understudied and urged that the NCI and other agencies to further MDS research. Building upon a large series of more than 1,600 primary MDS patients with detailed information on biological and clinical characteristics, we propose to 1) classify MDS cases into subgroups that are more homogeneous; 2) illustrate whether cases in different subgroups have distinct patterns of previous exposures (e.g. family history, medical history, cigarette smoking, alcohol drinking, exposure to occupational and environmental chemicals, and exercise); 3) describe the survival patterns of cases in different subgroups; 4) evaluate which factors determine the duration of survival; and 5) assess the health-related quality of life among surviving MDS patients. Compared with previous studies, the proposed research is distinguished by a remarkably large sample size and the comprehensiveness of data. Because of the availability of extensive data from previous research, only few resources are needed for additional data collection in this study. During the course of the study, Dr. Ma will be trained in cancer-related quality of life research, assessment of dietary factors, and application of spatial statistics methods and bioinformatics. Findings from the study will advance the knowledge about the biological heterogeneity of MDS, help guide future etiologic studies of MDS, offer insight into the determinants of survival, and better understand the quality of life of MDS survivors and factors affecting the quality of life. In addition, the award will provide a promising junior investigator a unique opportunity for career development in cancer research.